- Trinity Health (Boise, ID)
- …authorization on all clinical procedures, diagnostics and operative services requiring prior authorization from the insurance plan. Verify patient's insurance ... plan based on patient deductible and co-insurance responsibility. Communicates authorization and patient financial responsibility to clinic. **SKILLS, KNOWLEDGE,… more
- Sutter Health (Goleta, CA)
- …to verify patient eligibility, coordinate benefits, ensure insurance coverage, and determine if prior authorization is needed for said order. If needed, obtains ... authorization and documents in the patient electronic medical record. Facilitates responses to patient inquiries regarding authorizations within turnaround standards.… more
- SSM Health (St. Louis, MO)
- …service experience through the provision of benefits investigations and conducting prior authorization services. Develops a thorough understanding of payer ... reimbursement and patterns for pharmacy and medical claims with third parties. + Serves as primary ambulatory pharmacy resource to facilitate access to prescription and medical benefit medications. Including but not limited to; formulary/coverage issues, copay… more
- US Tech Solutions (May, OK)
- …based role that conducts clinical reviews of medical data collected to perform prior authorization for commercial and specialty medications. + The clinical ... denied prior authorizations. **Responsibilities:** + Evaluate and review all prior authorization requests and render coverage determinations based on… more
- Hartford HealthCare (Farmington, CT)
- …across the system. *_Position Summary:_* Under the direction of the Manager, Prior Authorization Services, HHC Cancer Institute, performs all clerical duties ... applicable. **_Position Responsibilities:_** **Key Areas of Responsibility** Monitors and reviews the prior authorization work queue daily to verify accuracy of… more
- University of Rochester (Rochester, NY)
- …internal equity considerations._ **Responsibilities:** Serves as the patient referral and prior authorization specialist, with oversight of data and compliance ... to enterprise standards and referral and prior authorization guidelines. Communicates regularly with patients, families, clinical and non-clinical staff,… more
- Fallon Health (Worcester, MA)
- …of purpose** : Under the direction of the Manager of Prior Authorization , communicates with contracted and non-contracted facilities/agencies/providers to ... collect pertinent prior authorization request data and disseminates information to the Authorization Coordinators. Additionally, supports the … more
- University of Rochester (Rochester, NY)
- …data and ensures compliance to enterprise standards and referral and prior authorization guidelines. Communicates regularly with patients, families, clinical ... follow up. Adheres to approved protocols for working referrals and prior authorizations. **ESSENTIAL FUNCTIONS** + Responsible for managing department referrals.… more
- Prime Healthcare (Chicago, IL)
- …West Talcott Ave, Chicago, IL 60631 Responsibilities The Infusion Insurance and Prior Authorization Representative assists with referrals by determining and ... are required. Preferred qualification: 1. Previous experience in pharmacy, infusion, or prior authorization process is preferred. Pay Transparency Saint Francis… more
- Eastern Connecticut Health Network (Manchester, CT)
- …are prevented. + Verifies insurance policy benefit information and obtains Authorization /Precertification prior to the patient's visit, scheduled surgery, ... POSITION SUMMARY: This position reports to the Manager, Central Authorization Center and works directly with FCC, ASC scheduling...Insurance eligibility and benefits and documenting in ADT system. ( prior to date of service and or upon admission).… more
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